Provider Demographics
NPI:1245744929
Name:BRASSEAUX, TRENT MATTHEW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:MATTHEW
Last Name:BRASSEAUX
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 MARILYN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4031
Mailing Address - Country:US
Mailing Address - Phone:337-349-9400
Mailing Address - Fax:
Practice Address - Street 1:233 DOUCET RD STE B2
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3403
Practice Address - Country:US
Practice Address - Phone:337-991-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist